Eating disorders are not the same as having a bad body image or wanting to be thin. They are biologically based illnesses, related to brain functioning, that puts one at risk for engaging in several life threatening behaviors, including restricting intake, bingeing, purging, using laxative and diet pills, or over exercising to a point of physical harm. College men with eating disorders cannot “just eat” or “stop” these behaviors. They need intensive treatment and medical care to overcome their eating disorder.
In the past, eating disorders have generally been considered a “girl’s disease.” For males with one of these disorders, this can mean many things. First, men are less likely to be identified as having an eating disorder by themselves, family, friends, or other adults. Questions are often not asked and behaviors such as restriction of intake, bingeing, and compulsive exercise – all of which have a high likelihood of being seen as of concern in females – may be seen as “normal” in males. Even if men do exhibit some of these behaviors, they are still unlikely to identify themselves as having an eating disorder. Second, even if identified, many will be resistant to the diagnosis and treatment of the eating disorder, as they do not want to be seen as having this “girl’s disease”. Thus, the mislabeling of eating disorders as exclusively female can be both sad and damaging to all males at risk.
The most common eating disorder for young men is a mixture of restriction/bingeing and over exercise. But all types of eating disorders, and all types of behaviors are seen in these young men. It may be associated with sports that encourage thinness, such as cross-country or track, with sports that tolerate purging (including wrestling and football), or a student may have an eating disorder with none of these activities. In these ways, men with eating disorders are much more like women than they are different. Whatever the actual numbers are, there is a large percentage of young men who are at risk. And college men who have eating disorders suffer and need treatment just as much as their female peers.
There needs to be a university-wide effort in reaching out to males on campus who may be struggling with body image and/or eating concerns. Outreach strategies need to be inclusive of men, and not just assume that only female students are struggling with these disorders. It is crucial that departments such as residential life programs, need to increase their training efforts with their resident assistants, so that they are better equipped to identify and intervene with their male peers in this area. In addition, counseling centers also need to become better equipped to appropriately intervene in these situations, with clear protocols outlining the most effective approach to treating men on campus who are dealing with this life-threatening illness. And finally, all campuses should have a list of resources, both on-and-off campus that can be provided to male students, so that they have the information and support needed to help them identify appropriate treatment options, depending on the severity of their illness.
Fortunately, treatment for men with eating disorders is better now than it has ever been. With the advent of Cognitive Behavior Therapy, Dialectical Behavioral Therapy, and Family Based Treatment, young adults have more options for better care and can have a very positive outlook for recovery from their eating disorder. Finding an evidence-based treatment team well versed in current knowledge and able to work as an integrated unit, while still challenging in some areas, is the most important first step in leading a full and healthy life.
Mark Warren, MD, MPH, FAED
Cleveland Center for Eating Disorders